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  • STEPUP MEDICAL PROTECTION PLAN

    Employee Voluntary Solutions - Portable medical protection

    Period

    WHOLE LIFE

    Insured issue age

    15 days-65 years

    You can buy this from

    Your Financial Planner

    Product Nature

    Medical protection insurance plan (Reimbursement)

    Plan Type

    Basic Plan


    WHAT THIS PRODUCT IS ABOUT?

    With a successful career to pursue and a family to raise, it’s more important than ever for you to take good care of yourself. That’s why we designed an enhanced medical protection plan for you.

    Available to existing members of the AIA group medical insurance scheme, the comprehensive StepUp Medical Protection Plan (StepUp) is a lifetime plan that tops up your group medical insurance. Application is convenient and simple with no medical underwriting required, enabling you to enhance your cover and prepare for future protection needs for just an affordable premium.

    Even if you leave the company or enter retirement, you will remain covered under StepUp, giving you and your loved ones the reassurance you need.

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    PORTABLE MEDICAL PROTECTION FOR A LIFETIME OF SECURITY

    what does it provide?

    • PORTABLE PROTECTION FOR EXTRA PEACE OF MIND
      PORTABLE PROTECTION FOR EXTRA PEACE OF MIND

      In life, it’s good to have an extra safety net. When you join StepUp, you can renew your cover every year for life. The renewal premium will be based on the prevailing premium rates at the time of renewal. Even if you leave the company, your group medical cover ends or you retire, your cover under this plan will continue, giving you protection at all times.

    • SIMPLE APPLICATION WITH NO MEDICAL UNDERWRITING REQUIRED
      SIMPLE APPLICATION WITH NO MEDICAL UNDERWRITING REQUIRED

      Application for this plan is convenient and simple with no medical underwriting requirement, ensuring you can obtain the protection you need with ease.

    • COVER FOR PRE-EXISTING CONDITIONS
      COVER FOR PRE-EXISTING CONDITIONS

      If you have been covered under our group medical insurance scheme and StepUp for a total duration of at least 12 continuous months, the pre-existing conditions you have will be covered under StepUp in the subsequent cover period, giving you immediate comprehensive protection.

    • COMPREHENSIVE COVER FOR YOUR MEDICAL EXPENSES
      COMPREHENSIVE COVER FOR YOUR MEDICAL EXPENSES

      StepUp offers you reimbursement for a range of medical expenses. This includes expenses such as hospital room and board, intensive care, surgery, hospital expenses, advanced diagnostic imaging (including tests performed in outpatient setting) and medical appliances.

       

      For more information, please read the “Benefits schedule for the StepUp Medical Protection Plan” in this brochure.

    • EXTENDED CARE SUPPORT FOR RENAL DIALYSIS AND CANCER TREATMENT
      EXTENDED CARE SUPPORT FOR RENAL DIALYSIS AND CANCER TREATMENT

      If you are unfortunately diagnosed with cancer or kidney failure, you will be in need of additional support. We therefore provide the extended caring protection for renal dialysis and cancer treatment to ease your worries and financial burden, helping you on the road to recovery.

    • Enhanced protection for medical expenses in HA hospitals with network reimbursement
      Enhanced protection for medical expenses in HA hospitals with network reimbursement

      To provide you with flexibility to arrange your medical treatment that best suits your needs, we cover your medical expenses from confinement to outpatient treatment in a HA hospital#. In addition, you can enjoy reimbursement and deductible of network benefits to obtain a more comprehensive support.

       

      #HA hospital refers to hospitals under the administration of the Hong Kong Hospital Authority (HA). You must confine in the public / general ward or receive outpatient treatment in the public / general section, and are charged according to the public charges for eligible persons, then we will make reimbursement of such charges in respect of network benefits subject to the maximum limits and deductible as shown in the benefits schedule for core benefits (except network clinical surgery benefit). Please refer to the definition of public charges and eligible persons on the HA website: www.ha.org.hk.

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    • QUALITY MEDICAL NETWORK PRIVILEGES
      QUALITY MEDICAL NETWORK PRIVILEGES

      To serve you better, our medical network comprises carefully selected medical service providers from across a range of medical disciplines.

       

      To offer you flexibility in the medical service we provide, you can select the medical service providers provided under an AIA group medical insurance scheme (if applicable) and StepUp if you are covered under both at the same time^.

       

      Even if you are no longer covered under AIA group medical insurance scheme, you can select the medical service providers provided under StepUp. Within this network, you can enjoy quality medical services and receive the following additional benefits in StepUp:

      •  90% of reimbursement for eligible expenses with no deductible for core benefits

        If you seek treatment within our medical network, we will reimburse 90% of your eligible expenses, and no deductible will apply.

       

      • Cashless arrangement for 4 designated surgical procedures at designated outpatient clinics

        You can use your electronic network card to book a designated surgery at a designated network clinic of StepUp’s medical service providers on a cashless basis, freeing you from the hassle of settling bills and making a subsequent claim.

        The 4 designated procedures are:
        1. lens operation including cataract removal and prosthetic lens insertion

        2. colonoscopy, with or without a biopsy or papilloma removal

        3. upper endoscopy up to the level of the duodenum

        4. excisions of skin lumps or a tumour of subcutaneous tissue, including lipomas, neurofibromas or its variants, sebaceous cysts and malignant melanomas, etc.

       

      The cashless arrangement is subject to a per disability limit and an additional per disability limit for network benefits, and you are required to settle the shortfall (if any).

       

      For more information, please refer to our network services leaflet for StepUp.

       

      ^ The network service providers under StepUp and AIA group medical insurance scheme (if applicable) are different. The use of StepUp’s medical network service is only applicable to the medical network protection under StepUp.

       

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    • Flexibility to suit your needs
      Flexibility to suit your needs

      We understand that everyone’s situation is different. That’s why we offer optional outpatient benefit to suit your personal medical needs. When you apply for this plan together with the optional outpatient benefit, there is no medical underwriting requirement*, allowing you to obtain a more comprehensive protection with ease.

       

      Plan Option

      • Plan 1 – Ward plan

      • Plan 2 – Semi-Private plan

      • Plan 3 – Standard Private plan

       

      Optional Benefit

      Plan 1 to 4 – Outpatient benefit

       

      Choice of plans will be subject to your existing AIA group medical insurance scheme cover, if any. For more information, please refer to “Plan selection rule” in the product brochure.

       

      *After the policy is effective, you can apply for the optional outpatient benefit on the policy anniversary date. Medical underwriting is required.

    insurance lingo explained

    Underwriting

    The process of reviewing an application and deciding whether the risk is acceptable at the standard premium or otherwise.


    Notes:
    1. All information here is for reference only. Please refer to the policy contract for the definitions of capitalised terms, and the exact and complete terms and conditions of coverage.

    2. We would like to remind you to review the relevant product materials and proposal illustrations (if applicable) provided to you and seek independent professional advice if necessary.

    3. This plan is an insurance plan without any savings element. All premiums are paid for the insurance and related costs.

    IMPORTANT INFORMATION

    IMPORTANT INFORMATION
    - Collapse + Expand
    ENROLMENT GUIDELINES

    Company participation guidelines

    Suitable for companies with:

    1. a minimum of 10 full-time employees; and
    2. an AIA group medical insurance scheme (not including voluntary or top-up policies)

     

    Member enrolment guidelines

    Eligibility: Suitable for members under an AIA group medical insurance scheme


    KEY PRODUCT RISKS
    1. You need to pay the premium for this plan for life. If you do not pay the premium within 31 days of the due date, the policy will be terminated and you / the insured will lose the cover.
    2. You may request for the termination of your policy by notifying us in written notice. Also, we will terminate your plan and you / the insured will lose the cover when one of the following happens:
      • the insured passes away;
      • you do not pay the premium within 31 days of the due date.
      We reserve the right to cancel this policy at any time by giving a 30-day prior written notice without cause to the policy owner. The unearned portion of the premium at the time of cancellation without interest shall be returned to you after deducting any debt owned by you to us under the policy.
    3. We underwrite the plan and you are subject to our credit risk. If we are unable to satisfy the financial obligations of the policy, you may lose your cover and the remaining premium for that policy year.
    4. Future medical costs will be higher than they are today due to inflation. Hence, the benefit amounts and the future premium rate of this plan may be adjusted to reflect inflation.
    5. Your current planned benefit may not be sufficient to meet your future needs since the future cost of living may become higher than they are today due to inflation. Where the actual rate of inflation is higher than expected, you may receive less in real terms even if we meet all of our contractual obligations.

    KEY EXCLUSIONS

    Under this plan, we will not cover conditions that result from any of the following events:

    1. Any treatment, investigations, services or supplies which are not medically necessary.
    2. Any pre-existing conditions for which the insured received medical treatment, diagnosis, consultation or prescribed medicines / drugs during the ninety (90) days preceding the effective date of this coverage unless the insured affected by these conditions has been insured under the AIA group medical policy and this plan for a total duration of at least twelve (12) continuous months.
    3. Any congenital defect that appears or is diagnosed before the insured reaches the age of 17.
    4. Self-destruction, intentional self-inflicted injury or drug abuse.
    5. War or warlike operations, civil commotion, any violation or attempted violation of law or resisting arrest, acts of terrorism where the insured is a terrorist, the use of atomic, biological or chemical contamination due to any act of terrorism, when the insured travels to a country at war, or where there is warlike operation, mutiny, riot, civil commotion, martial law or a state of siege, or a war zone as recognised by the United Nations.
    6. Pregnancy, miscarriage, child birth, voluntary termination of pregnancy, or complications of them, mental or nervous disorder, except for mental illness and emotional disorder benefit (see benefits schedule of optional outpatient benefit, item 5 for details), AIDS or any complications associated with HIV infection.
    7. Cosmetic or plastic surgery, dental care or surgery, corrective aids and the treatment of refractive errors unless necessitated by injury caused by an accident, body check-up, gradual recovery of health or rest care.

     

    The above-mentioned are for reference only. Please refer to your policy contract for the complete list and details of exclusions


    PREMIUM ADJUSTMENT AND PRODUCT FEATURES REVISION
    1. Premium Adjustment
      In order to provide you with continuous protection, we will annually review and adjust the premium of your plan accordingly at the end of policy year if necessary. During the review, we may consider factors including but not limited to the following:
      • claim costs incurred from all policies under this plan and the expected claim outgo in the coming year which reflects the impact of medical trend, medical cost inflation and product feature revisions;
      • expenses directly related to the policy and indirect expenses allocated to this product.

    2. Product Features Revision
      We reserve the right to revise the benefit structure, terms and conditions and/or product features, so as to keep pace with the times for medical advancement and to provide you with continuous protection.

     

    We will give the policy owner a written notice of any revision before any policy anniversary or upon renewal.


    Product Limitation
    1. We only cover the charges or expenses of the insured on a reasonable and customary basis.
      “Reasonable and customary” means:
      • the medical services, diagnosis and / or treatments are necessary and delivered according to standards of good medical practice;
      • the costs of the medical services and the duration of the hospital stay are not more expensive or longer than the usual level of charges or duration for similar treatment in the locality of such service delivered;
      • the medical procedure or treatment during hospital stay is not routinely performed on an outpatient basis and could not reasonably be performed on the insured member as an outpatient according to standards of good medical practice; and
      • does not include charges that would not have been made if no insurance existed.

      “Medically necessary” means that the medical services, diagnosis and / or treatments are:
      • delivered according to standards of good medical practice;
      • necessary; and
      • cannot be safely delivered in a lower level of medical care.

      Experimental, screening, and preventive services or supplies are not considered medically necessary. We may adjust any and all benefits payable in relation to any hospital / medical charges which is not a reasonable and customary charge.

    2. If the insured is covered by both AIA group medical insurance scheme and StepUp, where the contract terms and/or claim approach vary between two covers, we will make reference to the contract terms and/or claim approach of AIA group medical insurance scheme and assess the claim by StepUp on a special consideration basis. After membership termination in an AIA group medical insurance scheme/not covering in an AIA group medical insurance scheme, we will assess the claim application in accordance with the contract terms of StepUp.
    3. If any confinement, surgery and/or medical treatment covered by StepUp is also covered by other group medical policy (if any), you need to make claims in all such group medical policy before claiming the remaining balance of eligible medical expenses from StepUp.
    4. An “adjustment factor” is applied to the calculation of the benefit payable when the insured is confined in a hospital room of a type that is at a higher level than the room type corresponding to the plan level chosen, the benefit payable shall be paid according to the benefits schedule, and the adjustment factor will also apply. For details, please refer to the “Adjustment factor” in the brochure.
    5. An insured employee and insured dependant under an AIA group medical insurance scheme must enrol in the same plan, including core benefits and optional outpatient benefit, if applicable.
    6. Worldwide emergency assistance services are covered during the trip only (except for 24-hour worldwide telephone enquiring services), which are additional benefits. The services are provided by third party service provider(s). AIA shall not be responsible for any act, negligence or omission of medical advice, opinion, service or treatment on the part of them. AIA reserves the right to amend, suspend or terminate the service without further notice.
    7. If the eligible expenses have been reimbursed under any law, or medical program or other insurance policy provided by any government, company, other third party or us, such will not be reimbursable by us under this policy.
    8. Medical network services and cashless arrangement are additional benefits and do not form part of the contractual service. Medical network services are provided by network doctor. AIA shall not be responsible for any act or omission of network doctor in the provision of medical network services. AIA reserves the right to amend, suspend or terminate these services without further notice.

    Claim Procedure

    If you wish to make a claim, you must send us the appropriate forms and proof within 90 days of the date on which the covered event happened. You can get the appropriate claims forms from your financial planner, or by calling the AIA Customer Hotline on (852) 2232 8888 in Hong Kong, or (853) 8988 1822 in Macau, or by visiting any AIA Customer Service Centre. If you wish to know more about claim related matter, you may visit “File A Claim” section under our company website www.aia.com.hk.


    Cancellation Right

    You have the right to cancel and obtain a refund of any premiums and any levy paid by giving written notice to us. Such notice must be signed by you and submitted to the Customer Service Centre of AIA International Limited at 12/F, AIA Tower, 183 Electric Road, North Point, Hong Kong or the Customer Service Centre of AIA International Limited at Unit 1903, 19/F, AIA Tower, 251A-301 Avenida Comercial de Macau, Macau within 21 calendar days immediately following either the day of delivery of the policy or the Cooling-off Notice to you or your nominated representative, whichever is earlier.


    Like what you've read? This is just a summary of our product. If you want more information, please contact your financial planner for a financial needs analysis.

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    Contact aia

    We are pleased to announce that effective 22 February 2021, our customer service in Hong Kong will resume normal. However, please take note of the following special service hours for Macau.

    Macau

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    Sat, Sun & Public Holidays Closed

    Contact aia

    We are pleased to announce that effective 22 February 2021, our customer service in Hong Kong will resume normal. However, please take note of the following special service hours for Macau.

    Macau

    • Customer Service Centres & Hotline Service:
      • 10am - 4pm (Monday - Friday)

    Hong Kong

    (852) 2232-8888

    Hong Kong Island
    AIA Wealth Select Centre
    12/F, AIA Tower,
    183 Electric Road,
    North Point, Hong Kong

    Kowloon
    Suite 1313, 13/F,
    AIA Kowloon Tower,
    Landmark East, 100 How Ming Street,
    Kwun Tong, Kowloon, Hong Kong

    Mon-Fri: 8:45am – 6pm
    (Open through lunch)
    Sat, Sun & Public Holidays Closed

    Macau

    (853) 8988-1822

    1903, AIA Tower,
    Nos. 251A-301, Avenida Comercial de Macau, Macau
     
    Mon-Fri: 8:45am – 5:15pm
    (Open through lunch)
    Sat, Sun & Public Holidays Closed

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